Week 114: Pregnancy Flashcards
1
Q
What is cardiotocography (CTG)?
A
Continuous electronic monitoring of the fetal heart and uterine activity
2
Q
How is fetal heart rate monitored?
A
Using Doppler ultrasound
3
Q
Where is the transducer placed when monitoring the fetal heart?
A
Over the anterior shoulder
4
Q
What is a foetus’ heart rate controlled by
A
- Sympathetic system increases heart rate
- Parasympathetic decreases heart rate
- Maturity increases heart rate
- Also controlled by chemoreceptors and baroreceptors in the aortic arch
5
Q
What is a normal fetal heart rate?
A
110-150bpm
6
Q
What is the normal beat to beat variability in fetal heart rate?
A
5-15bpm
7
Q
What checks occur post delivery?
A
- Apgar score
- Birthweight
- Body temperature
- Head circumference
- Pass of urine/meconium within 24 hours
8
Q
What does the full neonatal exam consist of?
A
- Colour, breathing, behaviour, activity, posture, tone
- Head circumference
- Check fontanelles, palate, nose, ears, symmetry of head and facial features, assess eyes (red reflex)
- Limbs: proportions, symmetry, no. digits, congenital dislocation of hip
- CVS: HR, murmurs, arrhythmias
- Chest: auscultation, symmetry, signs of respiratory distress, respiratory rate
- Abdomen: assess or organomegaly, check umbilical cord insertion site
- Genitalia: exclude undescended testes in males
- Anus: exclude imperforate anus
- Spine: exclude spina bifida
- Note any birthmarks
9
Q
What is labour?
A
Regular painful contractions in the presence of cervical change
10
Q
What is the initial assessment of a woman in labour?
A
- Check temperature, pulse, BP, urinalysis
- Enquire regarding SROM (spontaneous rupture of membranes)
- Monitor contractions, check fetal heart rate
- Abdomen: presentation, lie, engagement
- Offer vaginal exam
11
Q
What is a partogram?
A
Graphical record of the maternal and fetal observations over time
- Maternal vital signs
- Uterine activity
- Analgesia
- Medications
- Fluid balance
- Fetal heart rate
- Cervical dilatation
- Fetal presentation and position
- Station of presenting part
- Presence of liquor and colour
12
Q
What is the attitude of the foetus?
A
The degree of flexion or extension of the head
13
Q
What is the suboccipitobregmatic diameter?
A
9.5cm
14
Q
What is optimal attitude?
A
So the suboccipitobregmatic diameter is presenting at the pelvic inlet
15
Q
What is the lie?
A
The long axis of the foetus relative to the long axis of the uterus
- Longitudinal
- Transverse
- Oblique
16
Q
What is presentation?
A
- Cephalic: longitudinal, occiput first
- Breech: feet first
17
Q
What is the position?
A
- Left occiput-anterior -> Most common
- Left occiput-transverse
- Left occiput-posterior
- Right occiput-anterior
- Right occiput-transverse
- Right occiput-posterior
18
Q
What is the station?
A
The leading bony edge of the presenting part relative to the ischial spines of the maternal pelvis
- If equal then 0
- Lower = +1/2/3…
- Above spines = -1/2/3…
Engaged at 0 and lower
19
Q
When is the foetus engaged?
A
At 0 and lower
20
Q
How many stages of labour are there?
A
3
21
Q
What is the first stage of labour?
A
- The onset of labour to full cervical dilatation
- Divided into latent and active phase
22
Q
What is the latent phase?
A
- The period between the onset of labour and a point at which a change in the slope rate of the cervical dilatation is noted
- Should be <20 hours
23
Q
What is the active phase?
A
- Greater rate of cervical dilatation
- Begins around 3-4cm dilatation
- Cervix should dilate a minims of 1.2cm/hour
24
Q
What is the second stage of labour?
A
- Commences when the cervix has reached full dilatation of 10cm
- Ends with delivery of the foetus
- Prolonged second stage is >3 hours
25
What is the third stage of labour?
- Delivery of the placenta and fetal membranes
| - Usually <10 minutes
26
What are the cardinal movements of labour?
- Engagement
- Flexion
- Descent
- Internal rotation
- Extension
- External rotation
- Delivery of anterior shoulder (expulsion)
- Delivery of posterior shoulder (expulsion)
27
What are maternal indications for induction of labour at term?
- Preeclampsia/eclampsia
- Diabetes mellitus
- Chronic renal disease
- Chronic pulmonary disease
28
What are maternal contraindications for induction of labour at term?
- Active genital herpes
| - Serious chronic medical conditions
29
What are fetal indications for induction of labour at term?
- Chorioamnionitis
- Abnormal antepartum testing
- Intrauterine growth restriction
- Post-term pregnancy (>42 weeks)
- Isoimmunisation
30
What are fetal contraindications for induction of labour at term?
- Malpresentation
| - Fetal distress
31
What are uteroplacental indications for induction of labour?
Placental abruption
32
What are uteroplacental contraindications for induction of labour?
- Cord prolapse
- Placenta previa
- Vaso previa
- Prior 'classical' cesarean
33
What are hormonal techniques to ripen the cervix?
⇒ Prostaglandins:
- Dinoprostone (PGE2)
- Misoprostol (PGE1)
⇒ Oxytocin
34
What are hormonal techniques to initiate or augment uterine contractility?
⇒ Oxytocin
⇒ Prostaglandins:
- Dinprostone (PGE2)
- Misoprostol (PGE1)
35
What methods other than hormones can be used to ripen the cervix?
```
⇒ Amniotomy
⇒ Membrane stripping
⇒ Mechanical dilators
- Hygroscopic dilators
- Balloon catheter
```
36
What methods other than hormones can be used to initiate or augment uterine contractility?
Amniotomy
37
What types of pain relief are mainly used?
- Entonox (gas and air)
- Epidural
- Pudendal nerve block
38
What is the APGAR scoring system?
```
Airway
Perfusion
Grimace
Activity
Respiratory effort
```
For neonates
- Score of 2 for each section if normal
- Score of 0 for each section if absent
39
What are the two surgical delivery procedures?
- Forceps
| - Vacuum
40
What are indications for surgical delivery?
- Maternal exhaustion
- Need to avoid maternal expulsive efforts
- Fetal stress
- Prolonged second stage of labour
41
What are indications for cesarean delivery?
```
⇒ Maternal
- Failed induction of labour
- Failure to progress (labour dystocia)
- Cephalopelvic disproportion
⇒ Uteroplacental
- Previous uterine surgery
- Prior uterine rupture
- Outlet obstruction (fibroids)
- Placenta previa, large placental abruption
⇒ Fetal
- Fetal distress
- Cord prolapse
- Fetal malpresentation (transverse lie)
```
42
What is the initial management of postpartum haemorrhage?
- Early recognition, monitor vital signs, O2
- Establish intravenous access, place urinary catheter
- Baseline laboratory values, alert anaesthesia, blood bank
- Correct hypovolaemia with crystalloid
- Central haemodynamic monitoring
- Correct anaemia/coagulation disorders
43
What are the pharmacological therapies for postpartum haemorrhage?
- Rapid oxytocin infusion (10-40 units/l)
- Methylergonovine (maximum 3 doses) [avoid in hypertension]
- 15-methyl-prostaglandin (Hemabate) (8 doses every 15-20 minutes) [avoid in asthma]
- Dinoprostone
44
What non-pharmacological management would be used in postpartum haemorrhage?
- Uterine packing
- Angiography and embolisation
- Explorative laparotomy with surgical options
45
What is the pharmacological management of preterm labour?
```
⇒ Calcium channel blockers
- Nifedipine
⇒ β-adrenergic agonists
- Terbutaline sulfate
- Ritodrine hydrochloride
⇒ Oxytocin antagonists
- Atosiban
⇒ Prostaglandin inhibitors
- Indomethacin
⇒ Magnesium sulfate
⇒ Others
- Nitroglycerine
```
46
When does the quadruple test panel occur?
15-20 weeks
47
What are the four markers the quadruple test panel uses?
- AFP
- β-hCG
- Inhibin A
- Estriol
48
When is an amniocentesis performed?
When a positive quadruple test panel comes back at 16-18 weeks
49
What is placenta praevia?
A placenta wholly or partly inserting into the lower segment
50
What is pre-eclampsia?
Proeinuric hypertension in pregnancy, developing after 20/40 weeks
